The Effect of Basal Bolus Insulin vs. Sliding Scale Insulin on Glycemic Control in Type 2 Diabetes Mellitus

The Effect of Basal Bolus Insulin vs. Sliding Scale Insulin on Glycemic Control in Type 2 Diabetes Mellitus At A Community Hospital

Author: Meriam Signo, DNP(c),MSN,PHN,RN NEA-BC,NE-BC

Project Goal: To assess the frequency of glycemic control, following the implementation of Basal Bolus Insulin (BBI) as compared to Sliding Scale Insulin (SSI) for hospitalized patients with Type 2 diabetes (T2DM)

Background: Diabetes is a life-threatening disease with chronic long-term complications: 30 million people. 95% are diagnosed with type 2 diabetes.

It is the 7th leading cause of death in the U.S. with an estimated cost of $245 billion (CDC, 2017). In 2016 the American Diabetes Association(ADA) stated that BBI is the preferred regimen. In 2017, EL Camino Hospital implemented basal-bolus insulin while continuing to use sliding scale insulin in the medical-surgical units. In 2016, prior to implementation, education was provided to direct care nurses on diabetes and basal bolus care management in the acute care setting.

Methodology: This was a retrospective, descriptive, study looking at a closed quantitative chart review of T2DM patients (BBI vs. SSI) May 2017 to May 2018 from medical-surgical units on both our campuses. The measures included average blood glucose levels and calculated HbA1c for two groups (BBI vs. SSI).

Participants age and length of stay was also evaluated. Data was analyzed using Statistical Package for the Social Sciences (descriptive statistics, Chi-Square test of association, Independent sample t tests). Level of statistical significance: p ≤ .05. Independent variable: BBI or SSI [patients were assigned to one treatment group] Dependent variable: random blood glucose levels at Point-of-Care Testing.

Results:

• A significant difference was found between the average BG for hospitalized patients with T2DM in the BBI group (M=201.12, SD =61.82) vs. the SSI group (M=175.09, SD =40.56); t(86)=2.46, p=.01
• A significant difference was found between calculated mean HbA1c for hospitalized patients with T2DM in the BBI group (M=8.76, SD=2.10) vs. the SSI group (M=7.72, SD=1.41); t(86)=2.76, p=.007
• The difference in the average age of 1.45 years between the SSI and BBI group was not statistically significant; t(88) = 0.043, p =.66
• The difference of 2.10 days in the average stay between the SSI and the BBI group was not statistically significant; t(88)=1.01, p=.31

Conclusions: When using SSI both the average blood glucose and the calculated HgbA1c was lower during the subjects stay in the hospital.

A BBI regimen remains the recommended practice by the ADA. This was a small study of 90 patients after the initial roll out of a new practice change.

Additional research with larger samples in different regions may be beneficial for future studies. Conducting studies at one to two years post implementation could determine if BBI leads to better glycemic control or SSI continues to have better glycemic control. Additional time may also add to nurses’ levels of comfort and familiarity with BBI and acceptance and understanding of this practice change and workflow. Providing education to nursing through simulation or a similar type of structured setting, such as developing a curriculum for new hires and conducting annual reviews could be explored.